Conoscere e riconoscere i propri errori. L importanza di un registro internazionale il modello EURAHS. Ferdinando Agresta

Transcription

1 Conoscere e riconoscere i propri errori. L importanza di un registro internazionale il modello EURAHS Ferdinando Agresta

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3 PAIN Related to Degree of the disease; Length DEVICES of surgery procedures (and as a consequence surgeon s experience); Single patient s medical history (related pathology) and reactivity FIXATION TECHNIQUES MESHES

4 BIOLOGICAL

5 Conoscere e riconoscere i propri errori. L importanza di un registro internazionale il modello EURAHS Ferdinando Agresta

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7 one might think there cannot truly be anything new in hernia repair, but nothing be further from the truth Hernia repair has been,and continues to be, written about in considerable volume in the medical literature. Part of this has to do with new techniques for repair, some is due to modifications of old technique, and much of the recent literature addresses many new meshes available for repair Voeller GR New developments in hernia repair. Surg Technol Int. 2003;11:111-6

8 with improved techniques in hernia surgery the emphasis for research has rightly shifted from recurrence rates to the effects on quality of life (QoL) Shoab, SSN Letter 3: Randomized clinical trial assessing impact of a LW of HW mesh on chronic pain after inguinal hernia repair (Br J Surg 2005; 92: ) Br J Surg 2005:92(5)

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10 First published: 16 March 2011

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16 Costs of meshes another important issue is the cost of meshes. There is today a huge price difference between the synthetic and biological meshes. The use of BMs in uncomplicated situations or in situations where they are not proven to act in favor of the synthetic meshes cannot be justified due to costs

17 (1) Large pores, (2) small pores, (3) additional features, (4) no pores,(5) 3D structure and (6) biological origin.

18 Pros & cons

19 consensus laparoceli

20 Risposta A Esegui già interventi laparoscopici per laparocele? ,25 1) SI 60 2) NO ,

21 Risposta 7 Per un laparocele di dimensioni massime minori di 4 cm l intervento di scelta è: ,6 1)laparoscopico 60 49,1 45,6 2)open 40 3)non so ,7 9, ,3 I Votazione II Votazione

22 Standardizing groin hernia repairs and improving outcomes requires that many questions be answered. Best operative techniques should have the following attributes: low incidence of complications (pain and recurrence), relatively easy to learn, fast recovery, reproducible results, and cost effectiveness. Treatment of groin hernia patients will improve if we honor all stakeholders interests (patients, hospitals, surgeons and society).

23 Evidence Based Medicine demands that the right patients received the right surgery done in the right clinic and performed by the right surgeons and speak the same language!! we do not have evidence enough to discuss on what mesh to use, what technique to use and in which clinical scenario. patients are too few to meet the statistical need for an adequate power in such studies even though an attempt seems to be in process a patient based uniform database (register) for universal registration is the most ideal form to bring more information on the results on inhomogeneous patient cohorts You will gather a large number of patients in a short time not only in specialist centers. Bad techniques and meshes can be sorted out from the market much earlier

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27 Evidence Based Medicine demands that the right patients received the right surgery done in the right clinic and performed by the right surgeons and speak the same language!! In summary, against a background of the intense discussions currently held on the evaluation of the benefits and safety of medical devices, it must be advocated that for the operations recorded in hernia registries, precise details of the meshes and fixation systems together with product names and manufacturers must be recorded. The extra effort needed here should definitely be made in the interest of patient safety. This would enable hernia registries to serve as an instrument for the evaluation of the benefits of the medical devices used in hernia surgery. However, with justifiable investment, insights could be gained additionally into scientific issues

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